Journal of the Formosan Medical Association最新文献

Background/purpose: The risk of hepatocellular carcinoma (HCC) is increased in patients with chronic hepatitis C (CHC) and elevated alanine transaminase (ALT) levels. The association between HCC and ALT levels after interferon (IFN) or direct-acting antivirals (DAA) therapy is unclear.

Methods: Patients with CHC receiving antiviral therapy were included in two large-scale cohorts in Taiwan (T-COACH and TACR). Posttreatment ALT levels were assessed at 24-weeks/12-weeks after the end-of-treatment with IFN/DAA. HCC risk after antiviral therapy were identified for evaluation.

Results: Of 29,926 CHC patients enrolled in the study, 64%, 22.5%, and 13.5% had posttreatment healthy-normal (female, ≤19 U/L; male ≤30 U/L), high-normal (female, 19-40 U/L; male, 30-40 U/L), and abnormal (>40 U/L) ALT levels, respectively. During a median follow-up of 2.4 years, 1245 patients developed HCC. The 5-year cumulative HCC incidence was 11.2% and 5.2% in the abnormal and high-normal ALT groups, respectively, compared to 2.7% in the healthy ALT group. In Cox regression analysis, factors associated with a higher HCC risk were advanced fibrosis, abnormal and high-normal posttreatment ALT levels, cirrhosis, and old age; whereas a sustained virological response (SVR) was associated with a lower HCC risk. The aforementioned impacts of abnormal and high-normal posttreatment ALT levels were observed across the SVR, non-SVR, and non-cirrhotic subgroups.

Conclusion: Patients with CHC with high-normal and abnormal posttreatment ALT levels have an increased risk of HCC; thus, HCC surveillance is still necessary in this population.

Background/purpose: In East Asian countries, the emphasis on academic achievement is pronounced. In recent years, rising youth suicide rates have raised concerns about a potential link to academic stress. The aim of this study was to explore the relationship between academic periods and student suicide rates.

Methods: Data on youth suicides (ages 12-21) from Taiwan's national cause-of-death file, spanning 2012-2022, were analyzed using Poisson regressions. The analysis was further stratified by sex and academic level.

Results: Among middle/high school students, suicide rates increased at the start of the second semester and slightly decreased during the winter break. No similar decline was observed during the summer break. Among undergraduate students, suicide rates also increased after the winter break, with an additional peak before the break. Male undergraduates showed decreased suicide rates during both winter and summer breaks, while female undergraduates showed no significant calendar-linked variation.

Conclusion: The association between academic periods and suicide rates differed by academic level and sex. A potential winter break effect, coinciding with the Lunar New Year, was observed in both middle/high school and undergraduate students. In contrast, a reduction in suicide rates during summer break was observed only among undergraduates, potentially reflecting sustained academic stress among middle/high school students even during summer break. Among undergraduates, only male students exhibited variations in suicide rates in accordance with the academic calendar, while no such variation was observed among female students. No sex-specific differences were identified in the middle/high school group.

Purpose: We estimated stage-specific loss of quality-adjusted life expectancy (loss-of-QALE) and weighted by stage distributions considering false-positive (FP) costs for cost-utility evaluation of mammography screening in Taiwan.

Methods: FP costs included related reimbursements by the National Health Insurance for inpatients' and outpatients' services within one year after positive screening without BC diagnosis. Using the EuroQol five dimensions questionnaire (EQ-5D-3L), we collected the utilities from 1,181 women who visited a medical center with 2,247 repeated measurements in 2011-2021. We used a rolling-over algorithm to extrapolate survival to lifetime to estimate QALEs by multiplying survival probability with utilities and the loss of QALEs by comparing with age- and calendar year-matched referents. We calculated the incremental cost-effectiveness ratio (ICER) yearly by comparing the stage proportion weighted sums of loss-of-QALE between women detected by screening versus non-screening within six-month observed intervals in 2004-2013.

Results: QALEs of stages I, II, III, and IV were 29.4, 25.0, 18.2, and 4.5 years, respectively, while loss-of-QALEs were 0.3, 4.2, 10.6, and 22.9 quality-adjusted life year (QALYs), respectively. A total of 355,489 (11.1 %) FP were found with an average cost of US$ 2,126 per screen-detected BC. After the nationwide promotion of mammography in 2010-2013, ICER was US$ 855 per QALY.

Conclusion: The mammography screening, which exceeded 530,000 women with a 22 % coverage rate, showed promising cost-utility; the ICER was about one-third of the willingness-to-pay (WTP) of one gross domestic product per QALY. Future studies are warranted to explore the saving of productivity loss from a societal perspective.

Background: Gestational diabetes mellitus as a common pregnancy complication carries metabolic risks for both the mother and infant. We and others have shown that ribonuclease L (RNase-L, an innate immunity regulator) regulates adipogenesis and insulin sensitivity of skeletal muscle. We further showed that its serum level was reduced in human subjects with impaired fasting glucose and metabolic syndrome. In this study we investigated its levels in gestational diabetes mellitus.

Methods: A total of 82 pregnant women who have received a one-step 75g oral glucose tolerance test (OGTT) for Gestational diabetes mellitus diagnosis were enrolled in this study, and their serum RNase-L levels during pregnancy were examined. Serum RNase-L levels were compared between women who did and did not develop Gestational diabetes mellitus. The risk for Gestational diabetes mellitus with the change of serum RNase-L concentration was estimated using a binary logistic regression model adjusting for age and body mass index.

Results: During pregnancy, serum RNase-L levels tended to descend with gestational age (P-for-trend = 0.008). The mean of serum RNase-L in the 1st, 2nd, and 3rd trimesters of pregnancy were respectively lower in the Gestational diabetes mellitus group compared with the controls (1st trimester: 17.1 ± 8.4vs.19.3 ± 7.2 μg/ml, P=0.328; 2nd: 14.7 ± 5.9vs.18.6 ± 6.8 μg/ml, P=0.017; 3rd: 13.6 ± 2.8vs.16.0 ± 3.5 μg/ml, P=0.005).

Conclusion: This is the first study on how innate immune factor affect the pregnant women in developing GDM. The serum RNase-L levels were found to be negatively associated with GDM risk during pregnancy. This observation linked GDM with innate immunity and RNA metabolism in its pathophysiology.

Background: Piriformis syndrome (PS) is a condition that causes low back pain. Ultrasound-guided injection (USI) has become a popular option for diagnostic block and treatment. Extracorporeal shockwave therapy (ESWT) is widely used for treating musculoskeletal diseases. However, few studies have compared the therapeutic efficacy of local steroid injections and ESWT.

Objectives: To compare the therapeutic efficacy of local corticosteroid injections and ESWT against PS.

Methods: This prospective randomized controlled trial enrolled 70 patients, who were randomly divided into two groups: the ESWT and USI groups. The ESWT group was subjected to one session of ESWT, and the USI group received one USI. Patients in both groups performed home-based stretching exercises. Evaluations were conducted at baseline and 1 and 5 weeks after the intervention. The outcomes included the patients' pain scores on a visual analog scale (VAS), Oswestry Disability Index (ODI), hip range of motion, side effects, and self-evaluation data.

Results: The groups did not vary significantly in terms of demographics. Significant time effects were observed in both groups, indicating post-treatment improvements. Furthermore, significant group effects were discovered in ODI and VAS pain scores. However, determining the superiority of one treatment over the other was challenging because of significant pretreatment differences between the groups in terms of ODI and VAS pain scores. However, no significant between-group difference was noted in the improvement rate.

Conclusion: ESWT and USI appear to be effective in the treatment of PS. The levels of efficacy of the two treatment approaches may be similar.

Clinical trial registration number: NCT04684537.

Purpose: To demonstrate the effects of postoperative oropharyngeal rehabilitation on inflammatory mediators and antioxidant capacity in adults with obstructive sleep apnea.

Methods: This quasi-experimental study enrolled participants without blinding between January 2020 and December 2022. Patients with obstructive sleep apnea were divided into a conservative treatment group (n = 17), surgery group (n = 23), or surgery combined with oropharyngeal rehabilitation (surgery + rehabilitation) group (n = 19). Polysomnography data and the concentration of inflammatory mediators and antioxidant capacity were determined at baseline, after 6 weeks of treatment, and after 18 weeks of treatment.

Results: Posttreatment percent changes in the apnea-hypopnea index in rapid eye movement sleep were positively correlated with that of IL-6 (0.641, 95% CI: 0.598 to 0.685; P < 0.001). Compared with the patients in the control group, those in the surgery + rehabilitation group had significantly reduced posttreatment percent changes in IL-6 (-77.273, 95% CI: -144.580 to -9.966; P = 0.024). In addition, the concentrations of IL-6 (-3.423, 95% CI: -6.638 to -0.207; P = 0.037) and matrix metallopeptidase-9 (-20.517, 95% CI: -40.584 to -0.450; P = 0.045) significantly decreased in the surgery + rehabilitation group. The total antioxidant capacity significantly improved in the surgery + rehabilitation group compared with in the surgery-only group (0.034, 95% CI: 0.005 to 0.063; P = 0.020).

Conclusion: The results reveal that postoperative oropharyngeal rehabilitation can reduce the serum levels of inflammatory mediators and increase antioxidant capacity. The combined treatment is more effective than surgery-only or conservative treatment.

Background: Emphasis on primary health care (PHC) is the most efficient and economical approach to achieving universal health coverage, and should serve as its foundation. The aim of the study is to examine academic publications from 2011 to 2023 in the Asia-Pacific region (APR) using the Web of Science (WoS) subject category of PHC.

Methods: Academic papers in the WoS PHC category published in the APR from 2011 to 2023 were retrieved and analyzed, including papers published in the Science Citation Index-Expanded and the Social Science Citation Index.

Results: A total of 5172 papers were published in the WoS PHC category from APR onwards. The annual number of publications and their citations increased from 2011 to 2023. Australia led PHC publications in the APR with 3918 publications (75.75% of APR regional output). New Zealand had the highest number of citations per paper (14.54) and the highest mean impact factor (3.25 ± 1.70). Publications in the WoS PHC category also covered a wide range of topics, including Medicine General Internal (70.86%), Health Care Sciences Services (18.10%), Health Policy Services (17.67%), and Public Environmental Occupational Health (17.67%), demonstrating the breadth of PHC research.

Conclusion: The annual number of publications and their citations in the WoS PHC category from the APR increased from 2011 to 2023. Australia and New Zealand have a significant presence in the PHC publications in the APR.